| NPI | 1912269796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MS AU5009697-2264) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL34822) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2013-07-02 |